Perinatal Depression
 

Overview

For most women, having a baby is a very exciting, joyous, and often anxious time. But for women with perinatal depression - formerly called postpartum - it can become very distressing and difficult. Perinatal depression refers to depression occurring during pregnancy or after childbirth. The use of the term perinatal recognizes that depression is associated with having a baby which often begins during pregnancy. 

Perinatal depression is a serious, but treatable medical illness involving feelings of extreme sadness, indifference and anxiety, as well as changes in energy, sleep, and appetite. It carries risks for the mother and child. An estimated 1 in 7 women experiences perinatal depression. 

Types Of Perinatal Disorders

Most people think that perinatal disorders are characterized only by sadness, anxiety and chronic fatigue. However, perinatal disorders have a variety of symptoms. Types of perinatal disorders include:

  • Perinatal Depression 
  • Perinatal Psychosis 
  • Perinatal Obsessive-Compulsive Disorder (OCD)
  • Perinatal Anxiety
  • Perinatal Panic Disorder
  • Perinatal Post-Traumatic Stress Disorder (PTSD)

Symptoms of Perinatal Depression

  • Persistent, generalized worry, often focused on fears for the health or wellbeing of the baby 
  • The development of obsessive or compulsive behaviors
  • Abrupt mood swings, or feeling constantly sad, low, or crying for no obvious reason 
  • Having little or no interest in all the normal things that bring joy 
  • Withdrawing from friends and family 
  • Finding it difficult to focus, concentrate or remember 
  • Having thoughts of death or suicide 
  • Increased sensitivity to noise or touch 
  • Changes in appetite: under or overeating 
  • Sleep problems unrelated to the baby’s needs 
  • Loss of confidence and lowered self-esteem 
  • Fear of being alone with baby 
  • Intrusive thoughts of harm to yourself or baby 
  • Increased drug use

Symptoms of Perinatal Psychosis

  • Extreme sudden mood swings, from very high to very low 
  • Out of character behavior 
  • Aggressive behavior 
  • A high level of agitation 
  • Irrational or delusional thoughts or beliefs, which may include irrational beliefs or thoughts about the baby 
  • Unusual or inappropriate responses to the baby 
  • Hallucinations and changes in sense perception, such as smelling, hearing or seeing things that are not actually there 
  • Paranoid or strange beliefs about the baby that cannot be countered by rational discussion 
  • Grandiose or unrealistic beliefs about your abilities as a mother 
  • Disordered or nonsensical thoughts and conversations
Causes of Perinatal Depression 

Pregnancy and the period after delivery can be a particularly vulnerable time for women. Mothers often experience immense biological, emotional, financial, and social changes during this time. Some women can be at an increased risk for developing mental health problems, particularly depression and anxiety. There's no single cause of postpartum depression, but physical and emotional issues may play a role. 

Physical changes: After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to perinatal depression. Other hormones produced by your thyroid gland also may drop sharply which can leave you feeling tired, sluggish and depressed. 

Emotional issues: When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you've lost control over your life. Any of these issues can contribute to perinatal depression. 

Risk factors

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if: 

  • You have a history of depression, either during pregnancy or at other times
  • You have bipolar disorder
  • You had peripartum depression after a previous pregnancy
  • You have family members who've had depression or other mood disorders
  • You've experienced stressful events during the past year, such as pregnancy complications, illness or job loss
  • Your baby has health problems or other special needs
  • You have difficulty breast-feeding
  • You're having problems in your relationship with your husband
  • You have a weak support system
  • You have financial problems
  • The pregnancy was unplanned or unwanted
Prevention

If you have a history of depression — especially perinatal depression — tell your psychiatrist if you're planning on becoming pregnant or as soon as you find out you're pregnant. 

During pregnancy, your psychiatrist can monitor you closely for signs and symptoms of depression. He may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy. 

After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of perinatal depression. The earlier it's detected, the earlier treatment can begin. If you have a history of perinatal depression, your doctor may recommend antidepressant treatment or psychotherapy immediately after delivery. 

Treatment
  • Psychotherapy: include CBT (cognitive behavior therapy) and IPT (interpersonal therapy).
  • Medication: Clinical guidelines for treating women with major depressive disorder who are pregnant or breastfeeding recommend psychotherapy without medication as a first-line treatment when the depression or anxiety is mild. For women with moderate or severe depression or anxiety, antidepressant medication should be considered as a primary treatment. 
Healthy Lifestyle Practices
  • Getting enough rest
  • Staying hydrated
  • Maintaining a healthy diet
  • Staying physically active through activities like walking exercising
  • You should contact your doctor if:
    • You are experiencing several of the symptoms above for more than two weeks
    • You have thoughts of suicide or thoughts of harming your child
    • Your depressed feelings are getting worse
    • You are having trouble with daily tasks or taking care of your baby